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Utah is steps away from banning insurance coverage of elective abortion and joining five other states with similarly restrictive laws.

HB354 was first pitched by Rep. Carl Wimmer, R-Herriman, as a safeguard against public money being used to fund abortion. Under the original version, health plans sold on government-run retail marketplaces known as exchanges would have not been permitted to cover elective abortions.

But an expanded, House-approved version of the bill would apply to all private insurance plans, prohibiting abortion coverage except in cases of rape and incest, where the woman's life or health are at risk or the fetus has a lethal defect.

"Most women, about 98 percent, pay with cash or credit for services," said Miriam Staker, director of Utah Women's Clinic in Salt Lake City. The price for a surgical procedure at 10 weeks gestation is $425 and $400 for the abortion pill.

"Women would rather pay out-of-pocket than talk to their insurance company," said Staker. Some are afraid their employer might learn of the procedure. Others haven't yet met their deductible and a good many are simply unaware that their policy may cover abortion, she said.

"We're always worried about policies that take benefits away from women," said Gretchen Borchelt, senior counsel at the National Women's Law Center in Washington, D.C. Women in Utah already earn less than their working male counterparts and are more vulnerable to losing their health insurance.

Five states restrict abortion coverage and at least 10 others, including Utah, are considering imposing limitations. Utah's proposed ban is more permissive than laws in Louisiana and Tennessee that outlaw abortion coverage altogether, according to the D.C.-based Guttmacher Institute.

But it's a significant change from the status-quo  one that seeks to "convince the American public that abortion isn't health care," said Adam Sonfield, the institute's senior policy analyst.

Surveys done in 2002 and 2003 by Guttmacher and the Kaiser Family Foundation showed anywhere from 46 percent to 87 percent of covered workers had coverage for abortion.

"To insurers it was just another surgical service, another billing code," said Sonfield.

But debate over national health reform  namely the federal subsidies it makes available to working class families  renewed debate on abortion coverage.

Contrary to what some anti-abortion groups have alleged, the new law does not mandate abortion coverage, said Sonfield. It preserves the status quo, leaving it to insurance companies to design policies, and complies with a decades-old ban on the federal funding of abortion. President Barack Obama signed an order clarifying that people cannot use federal subsidies to purchase policies that cover abortion.

Confusion over the law, however, and fear of public scrutiny has caused insurers to drop abortion coverage, Sonfield said.